Atrophic vaginitis

Inflammation of the mucous membrane of the vagina does not always have an infectious nature. In the period of extinction of fertility, the production of female sex hormones-estrogens decreases, which affects the state of reproductive organs. Ovaries and uterus diminish in size, thinning, becoming flabby walls and narrowing the diameter of the lumen of the vagina. Atrophic vaginitis is a complex of inflammatory symptoms associated with insufficiency of the blood supply, and hence - full nutrition of the tissues, of which the vaginal walls are composed. It is also called senile (senile) or postmenopausal colpitis, because, basically, this state develops in the period of age involution.

[1], [2], [3], [4]

Epidemiology

Statistics of complaints about vaginal discomfort indicate that, on average, seven to eight out of ten postmenopausal women (58 years and older) have this problem due to atrophic changes in the vagina. Manifestes this condition five to seven years after the onset of menopause.

[5], [6],

Causes of the atrophic vaginitis

Decreased estrogen production and the lack of these female sex hormones leads to the development of an inflammatory process in the vagina.

A normal hormonal level ensures the proliferation of cells of the mucous membrane of the vaginal epithelium, the production of vaginal secretions and blood supply in the tissues, that is, their nutrition and respiration.

The lack of these hormones leads to the development of atrophic changes - the walls of the vagina become thinner, smoothed out (they normally resemble small corrugations), the vaginal lumen narrows. The acidic environment of the vagina, which inhibits the development of opportunistic microorganisms, is also gradually becoming alkaline. Germs can reproduce. These processes contribute to the emergence of chronic recurrent inflammation - atrophic vaginitis.

The risk factors for this development are associated with a decrease in the production of estrogens, and this, in turn, is caused by physiological aging. In the postmenopausal period, the ovaries produce less estrogens as unnecessary, and many women in this age group begin to notice painful symptoms.

In addition, atrophic processes in the vagina can be the result of a surgical (ovarioectomy) or medication (taking medications that suppress the production of estrogens or their effect) menopause.

Radiation therapy of pelvic organs, endocrine pathologies, drug therapy, adherence to strict diets, anorexia, severe mental stress, bad habits are also considered among factors that increase the likelihood of developing atrophic vaginitis.

The pathogenesis of inflammation is triggered as a result of the above reasons or a combination of these. The multilayered flat vaginal epithelium gradually becomes thinner. His cells, normally containing glycogen, are replaced by connective tissue, which leads to a significant reduction in the number of Dodderlein sticks (lactobacilli) and the development of opportunistic flora. The amount of collagen fibers decreases and the elasticity of the organ walls decreases. They are more easily damaged and sag.

Deficiency of estrogens also leads to inadequate production of mucus containing substances that have antibacterial action (lysozyme, lactoferrin, defensins, zinc).

Multiple petechial hemorrhages at the onset of an atrophic process are usually combined with aseptic inflammation. Pain during sexual intercourse, itching and burning, especially when irritating the external genitalia, is considered as a consequence of hypoxia and the spread of the atrophic process to the zone of the labia minora. Scleroziruyut also the tissues of the vaginal ring (krauroz vulva). It is believed that vaginal discharge that occur in aseptic inflammation is caused by damage to the lymphatic vessels (lymphorrhea or lymphorrhage). This condition is usually resistant to hormonal therapy. All of the above processes create very favorable conditions for secondary infection. The consequence of disturbing the normal vaginal ecosystem is chronic inflammation, localized in the vagina.

[7], [8]

Symptoms of the atrophic vaginitis

The first signs are expressed by a slight discomfort, which women often do not pay too much attention to. Basically - it's dryness of the vaginal epithelium, lack of lubrication, which experts associate with circulatory insufficiency in the vessels of the vaginal wall. Consequently, atrophic changes develop not only in the epithelium, but also in the network of vessels, as well as the muscular corset wall. It is assumed that it is oxygen starvation that leads to a proliferation of capillary mesh that is noticeable during visual inspection and is a specific sign of atrophic vaginitis. The presence of a large number of capillaries in the epithelium explains and high contact bleeding.

Atrophic changes occur gradually and together with them the symptomatic increases - hypoxic changes look like multiple ulcers in the epithelial membrane. It becomes noticeable atrophy of the cervix and the uterus itself, the proportions of their sizes acquire proportions of 1: 2, which is characteristic for childhood.

Allocations with atrophic vaginitis are minor. They look like liquid watery leucorrhoeas (aseptic inflammation). Often, patients complain of dryness and burning in the vagina, more pronounced during urination or hygienic procedures. They may be disturbed by discomfort in the lower abdomen, itching and sensation of burning pain in the area of the external genitalia.

Sexual intimacy does not bring pleasure, because the vaginal secret is not enough. Because of the lack of lubrication, women may experience pain during sexual intercourse, and after that, sometimes little bloody discharge appears. The thin and dry vaginal epithelium is easily damaged and quickly begins to bleed.

Secondary infection is manifested by symptoms characteristic of the associated infection: curdled white flakes - with candidiasis, greenish - when breeding pyogenic flora, etc.

Atrophic vaginitis, like all chronic diseases, flows wavy - exacerbations are replaced by a latent period, when symptoms are completely absent. The disease has a sluggish character, marked signs of inflammation appear at a late stage of the disease or with the addition of a secondary infection.

Types of atrophic changes in the vaginal epithelium are considered in terms of the causes that caused the onset of menopause. Postmenopausal atrophic vaginitis is the result of a natural aging of the body. A similar condition, acquired as a result of artificial menopause, is considered separately.

[9], [10], [11], [12]

Complications and consequences

Violation of acid-base equilibrium leads to dysbacteriosis of the vagina and unhindered reproduction of pathogenic microorganisms.

Violation of tissue trophism, destructive changes in them can lead to the omission of the walls of the vagina and the prolapse of the uterus, which can result in a blockage of the urethra and a violation of the outflow of urine. By the age of 80, 20% of women suffer from genital depressions, the main method of eliminating this pathology is surgical treatment.

Atrophic vaginitis is often complicated by frequent cystitis, urinary incontinence and other problems of the genitourinary tract.

Lack of interest in sexual life, caused by a decrease in the level of estrogen and discomfort during and after coition, can cause the destruction of family relationships.

[13], [14], [15]

Diagnostics of the atrophic vaginitis

The doctor, having heard the patient's complaints and her answers to the questions of interest, conducts an examination on the gynecological chair during which the removal of smears from the vagina and cervix for microscopic examination. Cytological (to determine cellular changes) and bacterioscopic (on flora) analyzes of collected biological material are made.

The atrophic type of smear on the cytogram shows that the epithelial layer contains basal cells and leukocytes. This indicates a nearly complete destruction of the mucous layer of the vagina and a sharp estrogen deficiency. This type of smear corresponds to the diagnosis of atrophic vaginitis.

An easier degree of atrophy corresponds to a smear in which, in addition to basal cells and leukocytes, intermediate - parabasal cells are contained. Sometimes there is no inflammation, then there are no leukocytes. But the presence of basal cells indicates the onset of an atrophic process.

Instrumental diagnosis necessarily includes colposcopy, which allows you to clearly visualize the mucous membrane of the vagina and the adjacent part of the cervix. This study allows you to see the thinning of the walls, the foci of hemorrhages on them. Patients who do not suffer from sensitization to iodine, during the colposcopy the Schiller test is performed. If the tissues are stained badly, not evenly, their atrophic changes are diagnosed.

In addition, it is recommended that the material of the vaginal and cervical secret be examined using a polymerase chain reaction to detect hidden infections.

If necessary, ultrasound of the pelvic organs, general blood and urine tests can be prescribed.

[16], [17], [18], [19]

Differential diagnosis

Differential diagnosis of atrophic vaginitis is carried out with inflammation of the genitourinary organs of infectious etiology.

Treatment of the atrophic vaginitis

Details about the treatment of atrophic vaginitis can be found here.

Prevention

Age changes can not be avoided, but you can meet them fully armed. It is possible to significantly slow down atrophic processes in the vaginal wall, trying to follow not too complicated rules.

Monitor your diet: include in the diet products containing phytoestrogens. There are many such products. These are beans - beans, common and asparagus, peas, lentils, soybeans; seeds - pumpkin, linseed, sesame; vegetables - carrots and beets, tomatoes and even cucumbers; fruits - apples, pomegranates, dates.

Also, regular use of fermented milk products promotes normalization of acidity in the vagina, and consumption of at least two liters of pure, non-carbonated water per day will support the water balance of your body and increase the production of vaginal mucus.

Regular sexual life helps improve blood circulation in the pelvic organs and stimulates the production of estrogen.

Convenient natural linen, careful intimate hygiene neutral hypoallergenic drugs will play its positive role in the prevention of atrophic vaginitis.

Fat layers in the female body are predetermined by nature, they play an important role in the synthesis of hormones, so it's too much to get involved in fashionable diets, you should not starve. It's not about the benefits of being overweight, but its lack is also detrimental to the female body.

Do yoga, some asanas promote adrenal stimulation, others - prevent stagnant phenomena in the pelvic area, do any sets of exercises that train the muscles of the pelvic floor. The World Health Organization, whose authority is unquestionable, concluded that the development of all pathological processes begins with stagnation. The activation of blood circulation hampers their development.

Say goodbye to bad habits, increase stress resistance, then, perhaps, hormone replacement therapy, you will not need.

[20], [21], [22], [23]

Forecast

There are many methods of preventing atrophic vaginitis. The main thing is not to start the disease and not to engage in amateur activity if you still have to resort to hormone replacement therapy. This technique has helped many women survive menopause without complications. However, to avoid side effects, it is necessary to comply with the regimen prescribed by the doctor.

[24], [25], [26]